Living With Food: The Science Supporting Eating Disorder Treatment

By Dr. Jorey Friedman Beegun and Dr. Mark Warren

In Family Based Treatment (also known as the Maudsley method), parents play an active role in refeeding their child with the goal of restoring their child's weight to a range that is appropriate for their age, height and optimal medical and psychiatric functioning (as determined by a team of professionals and tailored specifically to the child). Once that has occurred, the parents gradually return control of eating back to the adolescent in a manner that stabilizes weight and behavior and allows for a focus on adolescent developmental issues that are often thrown off track by the illness.

Phase I of the Maudsley method in treating anorexia involves a shift of total control of eating from child to parents during which time the parents are responsible for making all choices surrounding food and re-feeding the adolescent. This first phase of treatment is critical because of need for the child to be gaining weight during a time in which their brain is malnourished and the fear of weight gain is acute. Given that many of the thoughts associated with anorexia nervosa are side effects of malnourishment itself, having an individual therapist or family member try to "convince" the adolescent to eat and gain weight is not successful and has no empirical support. What their brain needs is food and Phase I coaches the parent on providing their child the medicine (food) they need.

Phase II commences when a child has been successfully re-fed and parents believe that the child is ready to attempt to re-gain some control over their eating and food choices. Phase II extends from the very first collaborative moment around eating between the parents and child until the point where the child is able to successfully feed him or herself on a regular basis. This does not mean that the child will have no eating disordered thoughts, feelings, or body image issues as the time in which is takes for these to diminish or dissolve entirely is different for each child. However, the child's ability to tolerate and process these feelings is such that they can be working on eating independently in a gradual fashion.  Thoughts, feelings, and body image can be successfully addressed in phase III when normal teenage issues move into the forefront.

Phase III begins when the adolescent is able to maintain appropriate body weight and restriction has stopped. The focus shifts to an exploration of how the eating disorder has impacted the formation of a healthy adolescent identity and works to help both the parents and adolescent get back on track in terms of supporting age-appropriate developmental tasks.

It is important to note that the there are differences between the phases in FBT for those struggling with Bulimia Nervosa and Eating Disorder, Not Otherwise Specified given that those adolescents are often weight-restored. The Maudsley Method is more collaborative with these diagnoses, the degree of which is clinically determined during the initial Maudsley sessions. 

Contributions by Sarah Emerman